PCNA在接受过术前经导管肝动脉栓塞化疗的肝癌组织中的表达及其预后意义

背景与目的:增殖细胞核抗原(proliferating cell nuclear antigen,PCNA)可反映肝细胞癌(以下简称"肝癌")的增殖活性,经导管肝动脉栓塞化疗(transcatheter arterial chemoembolization,TACE)对术后残癌细胞增殖活性影响的报道结果不一。本研究旨在探讨术前TACE对肝癌增殖活性的影响和PCNA在二期切除肝癌复发预后中的意义。方法:选取91例术前TACE及50例未行TACE的肝癌手术切除标本,采用免疫组化方法检测两组标本PCNA的表达情况,分层分析两组PCNA表达的差异,以及术前TACE后二期根治性切除的肝癌中PCNA的表达水平与复发的关系。结果:PCNA表达于肝细胞核中,术前TACE组和未行TACE组的PCNA阳性率分别为67.0%和66.0%(P>0.05),术前TACE组中癌栓、播散结节或肿瘤低分化(Ⅲ～Ⅳ级)者PCNA的表达均明显低于对应分层的未行TACE者,差异有统计学意义(P<0.05)。术前TACE后根治性二期切除患者,复发组与未复发组肿瘤组织中PCNA阳性率分别为77.8%、47.1%,差异有统计学意义(P<0.05)。PCNA阳性组1、3、5年无瘤生存率分别为55.8%、31.8%、23.6%,PCNA阴性组分别为83.2%、62.1%、53.2%,差异有统计学意义(P<0.05)。结论:术前TACE对高侵袭肝癌细胞增殖活性有较好的抑制作用,术前TACE后二期根治性切除肝癌PCNA的表达与患者术后复发转移密切相关。

Expression and prognostic value of proliferating cell nuclear antigen in hepatocellular carcinoma patients received preoperative transcatheter arterial chemoembolization

BACKGROUND & OBJECTIVE: Proliferating cell nuclear antigen (PCNA) could indicate cell proliferation of hepatocellular carcinoma (HCC), while the impact of preoperative transcatheter arterial chemoembolization (TACE) on cell proliferation of HCC is still uncertain. This study was to investigate the expression and prognostic value of PCNA in HCC patients underwent preoperative TACE. METHODS: The expression of PCNA in 91 specimens of HCC with preoperative TACE (TACE group) and 50 specimens of HCC without preoperative TACE (non-TACE group) was detected by immunohistochemistry. The expression of PCNA between the 2 groups after stratification were compared. Correlation of PCNA expression to tumor recurrence was analyzed. RESULTS: PCNA was expressed in cell nuclei. The positive rates of PCNA were 67.0% in TACE group and 66.0% in non-TACE group (P>0.05). In patients with disseminated nodules, portal vein invasion and poorly differentiated tumor, the positive rates of PCNA were significantly lower in TACE group than in non-TACE group, respectively. In patients who underwent curative resection after preoperative TACE, the positive rates of PCNA were significantly higher in recurrence group than in non-recurrence group (77.8% vs. 47.1%, P<0.05). The 1-, 3-, and 5-year disease-free survival rates were significantly higher in PCNA-negative group than in PCNA-positive group (83.2% vs. 55.8%, 62.1% vs. 31.8%, and 53.2% vs. 23.6%, P<0.01). CONCLUSIONS: Preoperative TACE inhibit cell proliferation of the HCC with disseminated nodules, portal vein invasion or poor differentiation. The expression of PCNA is closely correlated to postoperative recurrence of HCC patients who underwent preoperative TACE.